Article

Project-based Housing First for chronically homeless individuals with alcohol problems: within-subjects analyses of 2-year alcohol trajectories.

Addictive Behaviors Research Center, University of Washington, Seattle, WA 98104, USA.
American Journal of Public Health (Impact Factor: 4.23). 03/2012; 102(3):511-9. DOI: 10.2105/AJPH.2011.300403
Source: PubMed

ABSTRACT Two-year alcohol use trajectories were documented among residents in a project-based Housing First program. Project-based Housing First provides immediate, low-barrier, nonabstinence-based, permanent supportive housing to chronically homeless individuals within a single housing project. The study aim was to address concerns that nonabstinence-based housing may enable alcohol use.
A 2-year, within-subjects analysis was conducted among 95 chronically homeless individuals with alcohol problems who were allocated to project-based Housing First. Alcohol variables were assessed through self-report. Data on intervention exposure were extracted from agency records.
Multilevel growth models indicated significant within-subjects decreases across alcohol use outcomes over the study period. Intervention exposure, represented by months spent in housing, consistently predicted additional decreases in alcohol use outcomes.
Findings did not support the enabling hypothesis. Although the project-based Housing First program did not require abstinence or treatment attendance, participants decreased their alcohol use and alcohol-related problems as a function of time and intervention exposure.

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Available from: Seema L Clifasefi, Jul 08, 2015
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    • "For these reasons, the current study included only the 95 participants in the project-based HF group. Additional information on parent study recruitment methods , the project-based HF intervention, measures, and outcomes are published elsewhere (Clifasefi, Collins, Tanzer, Burlingham, & Larimer, 2011; Collins et al., 2012; Larimer et al., 2009). The University of Washington and King County Mental Health, Chemical Abuse and Dependency Services Division Institutional Review Boards reviewed and approved these procedures. "
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    ABSTRACT: BACKGROUND: Project-based Housing First (HF) programs provide immediate, permanent, low-barrier, nonabstinence-based supportive housing to chronically homeless people within a single housing project. Previous studies have shown project-based HF is associated with 6-month reductions in jail time (Larimer et al., 2009), and that people with criminal histories are able to maintain their housing in supportive housing, such as project-based HF (Malone, 2009; Tsai & Rosenheck, 2012). This study aimed to extend these findings to document the criminal histories of project-based HF residents and to test the associations among exposure to project-based HF, criminal histories and jail time over a 2-year follow-up. METHODS: Participants (N=95) were chronically homeless individuals with severe alcohol problems who moved into project-based HF. Measures included administrative data on criminal history, project-based HF exposure, and jail days and bookings for two-years prior to and subsequent to move into project-based HF. RESULTS: The majority of all past criminal convictions were misdemeanors (91.3%). Further, criminal convictions did not predict participants' housing retention in project-based HF. Months of project-based HF exposure - not prior criminal histories - predicted significant decreases in jail days and bookings from the two years prior and subsequent to participants' move into HF. CONCLUSIONS: Findings suggest that participants' criminal histories primarily reflect "symptoms" of homelessness rather than threats to public safety. Further, the extent of participants' criminal histories was not associated with subsequent jail time or housing attrition. Although causation cannot be implied, these findings show that the amount of time spent in project-based HF is associated with decreased jail time for up to two years following initial HF exposure.
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    ABSTRACT: Housing first (HF) programmes provide low-barrier, nonabstinence-based, immediate, supportive and permanent housing to chronically homeless people who often have co-occurring substance-use and/or psychiatric disorders. Project-based HF programmes offer housing in the form of individual units within a larger housing project. Recent studies conducted at a specific project-based HF programme that serves chronically homeless individuals with alcohol problems found housing provision was associated with reduced publicly funded service utilisation, decreased alcohol use, and sizable cost offsets. No studies to date, however, have qualitatively explored the role of alcohol use in the lives of residents in project-based HF. We collected data in a project-based HF setting via naturalistic observation of verbal exchanges between staff and residents, field notes taken during staff rounds, and audio recorded staff focus groups and resident interview sessions. Qualitative data were managed and coded using a constant comparative process consistent with grounded theory methodology. The goal of the analysis was to generate a conceptual/thematic description of alcohol's role in residents' lives. Findings suggest it is important to take into account residents' motivations for alcohol use, which may include perceived positive and negative consequences. Further, a harm reduction approach was reported to facilitate housing attainment and maintenance. Residents and staff reported that traditional, abstinence-based approaches are neither desirable nor effective for this specific population. Finally, elements of the moral model of alcohol dependence continue to pervade both residents' views of themselves and the community's perceptions of them. Findings suggest it is necessary to set aside traditional models of alcohol use and approaches to better understand, align with, and address this population's needs. In doing so, we might gain further insights into how to enhance the existing project-based HF approach by applying more tailored, alcohol-specific, harm reduction interventions.
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    ABSTRACT: The Housing First (HF) approach is a model of housing that entails the provision of immediate, permanent, low-barrier, supportive housing to chronically homeless individuals either in separate apartments within a larger community (known as scattered-site HF) or in a single building (known as project-based HF). One recent innovation is the application of project-based HF with chronically homeless individuals with alcohol problems. Although initial studies have shown its effectiveness, there is currently no research on residents' and staff 's experiences living and working in a project-based HF program. The purpose of this article was to document these experiences and highlight strengths and challenges of project-based HF programs. Using data collected from naturalistic observations, agency documentation, one-on-one resident interviews, and a staff focus group, we delineated transitional periods, including moving into project-based HF, community-building, managing day-to-day, and transitions from project-based HF. Findings are interpreted to help health care policymakers and providers envision the role of project-based HF in comprehensive public health efforts and to integrate lessons learned into their own clinical practice.
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